TITLE ORDER FORM Return to ATG Title Services Via Fax: 855.827.3568 Or Email: [email protected]

TITLE ORDER FORM Return to ATG Title Services Via Fax: 855.827.3568 Or Email: Orders@Atgf.Com

TITLE ORDER FORM Return to ATG Title Services via Fax: 855.827.3568 or Email: [email protected]

Order Date: Delivery Method: (If none specified, we will send via email.)  Email: Date Needed:  US Mail  Pickup  UPS Next Day ($10.00 added to Title Preparation Fee)  Fax:

Ordered By: Member No.: Phone No.: Fax No.: Email: Transaction Type: Type of Property:  Purchase (with mortgage)  Single Family  Cash Deal  Condo  Refinance  Townhome/Coach House  Foreclosure  Commercial  Condo Conversion Master Commitment  Mixed Use  Tract Search  Vacant Land  Search Only  Apartment Building/2-3 Flat No. of units:

BORROWER(S) BUYER’S ATTORNEY Name: Name: SSN (Last 4 digits) or FEIN (in full)*: Address: Name: City, State, Zip: SSN (Last 4 digits) or FEIN (in full)*: Phone: Fax: Address: Email: City, State, Zip: SELLER’S ATTORNEY County: Name: * Non-purchase money mortgage transactions only. Address: SELLER(S) City, State, Zip: Name: Phone: Fax: SSN (Last 4 digits) or FEIN (in full): Email: Name: REAL ESTATE AGENT SSN (Last 4 digits) or FEIN (in full): Name: Address: Phone: Fax: City, State, Zip: Email: Phone: Fax: COOPERATING REAL ESTATE AGENT SELLING PROPERTY Name: Address: Phone: Fax:

Email: City, State, Zip: County: PIN:

ATG FORM 4221 FOR USE IN: IL © ATG (REV. 2/18) Page 1 of 2

LENDER

First Lender Name: Second Lender Name: Contact Name: Contact Name: Address: Address: City, State, Zip: City, State, Zip: Phone: Fax: Phone: Fax: Email: Email: First Mortgagee Clause: Second Mortgagee Clause:

Endorsements: Are any titleholders deceased?  Yes  No  ARM  Condo  Location Name(s):  Balloon  EPL  PUD Purchase Price: $  Other: Loan Amount: $ Second Loan Amount: $ Two Commitments required?  Yes  No

WATER CERTIFICATE/ZONING CERTIFICATE PRIOR POLICY (City of Chicago Only)  Yes, attached (Both Schedules A & B)  Yes, I would like to order through AT G.  No (You will be provided with a Request for Water and/or Zoning Certification (ATG Form 4027), which is also available on our website, www.atg.fom. For more information, contact the ATG Search Department at 312.372.1735.)

ADDITIONAL INSTRUCTIONS

Ensure encryption or password protection is utilized when transmitting Non-Public Personal Information (NPI) electronically. Alternatives to encryption, such as password protection (e.g., Adobe PDF password protection) of files or transmission by facsimile, are acceptable forms of protecting information.